Thomas L. Chiu FROM THE COUCH TO THE JUNGLE
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Postscript

What will the 21st century hold for me? And for other psychiatrists, who are increasingly being forced, by social conditions and trends, to treat multicultural populations in America and most other countries around the world? I cannot predict the future, of course. But I am certain that, in my own case, there are bound to be many surprises, as there have been throughout my life-beginning with my departure from China to the Philippines, and continuing over the past 30 years of my professional life, when I began my "multicultural odyssey" as a psychiatrist in Sarawak.

Last year, by the way, I actually revisited Sarawak-after a hiatus of 29 years. Why? I did not go to do follow-up research or chase some dream of another research project. Rather, I took a sentimental journey, of sorts, to see the field workers and their families involved in the original research project. During my visit, the most touching thing that caught my attention was in the restaurants they took me to: On the checks, a caption was written that said a certain percentage of the taxes go to mental health programs! How happy I was to see this positive residue of our long-ago effort in Sarawak!

As I look back on my career, from the 1960s to the 1990s, I see that I have been inexorably drawn to the many instructive, dramatic, and bizarre occurrences that came along, as I studied, learned, and grew with the psychiatric movement in America. A thirty-year span is, indeed, a long time for someone-even a trained Psychiatrist-to recapture his own perceptions, and to make them meaningful to lay readers, as well as to professional mental health workers. These recollections, no doubt, have at times appeared clouded. Nonetheless, in this book I have attempted to gather and organize materials chronologically from the different healthcare institutions and projects in which I have participated, as a student, researcher, and practitioner, and to present my views about them and the patients we have studied and treated.

Throughout much of the 20th century, I have flowed like a river, so to speak, from sea to sea. From one culture to another. From one kind of thinking to another. There has been so much to assimilate and make sense of. Along the course of my travels, I have wondered, among many other things, How does each culture attempt to cope with and solve each mental health problem? Is there the possibility of establishing uniform ways of coping with mental health problems for all cultures? I have yet to arrive at definitive answers, but I do feel an enormous sense of progress being made by my profession, at least in the area of psychopharmacology. Could it be that "popping a pill" or "getting a shot" will, indeed, be the solution to our most pressing mental health problems in the near future? They may be, especially if medical researchers continue the present trend of attributing more and more behaviors-and even thinking and feeling-to genetic and biochemical factors.

In my travels, however, I have seen that a simple, caring, human approach can also benefit the mentally ill. This fact was made very clear to me on a recent trip to Malta, where I took an impromptu tour of the mental health facility of the General Hospital in Gozo, an island easily approached by ferry from the main island. The facility, separated from the hospital physically, is situated in the hilly section of town, which is quite idyllic for contemplative repose.

The building is one story high. Spread spaciously in a semicircular fashion are the different units of services, including outpatient care, short-term stay, long-term stay, and a geriatric component. The staff is composed of two fulltime psychiatrists and an indeterminate number of social workers and psychologists. In addition, two fulltime priests alternate on a 24-hour basis, offering multiple services, such as individual and family counseling, patient advocacy, and home visits to assess crisis situations.

Though my visit was very brief, I came away with a good feeling, and was impressed by the care given to the mentally disabled by the professionals in the various disciplines and the nonclinical staff. To me, it looked like one big family sharing all kinds of vicissitudes of life and coping with them. My experience on this tiny, Mediterranean island reinforced my conviction that one does not need to have the powerful technologies of modern psychiatric institutions to reach the mentally ill.

From the very beginning of my psychiatric training, to my exposure to the diversity of patients I have seen and treated, I have been very fortunate. I've also been fortunate to have worked with so many fascinating, intelligent, and caring colleagues and collaborators from myriad ethnic backgrounds. This good fortune continues right to the present time, as in my association, for example, with the Guatemalan social worker at Sunset Terrace who gives me insight into her country's historical upheaval and struggles for human rights.

Although I feel, at times, that I have "swallowed the world" from my diverse transcultural experiences, I realize that my personal odyssey represents but a narrow path, a small span, a minuscule portion of the whole spectrum of the mental health movement. My "crossings" over and through this movement have been atypical-perhaps even irreverent-compared to the career paths of conventional psychiatrists, who typically work in placid, private practice or institutional settings, and treat patients similar in terms of socio-cultural and demographic characteristics.

While I may have deliberately moved away from the traditional road, I also may have been swayed by the myriad opportunities that came along these past 30 years. I rationalize that there will eventually be changes of policies and privileges affecting psychiatric practice, as we move on to the 21st century. So I have taken chances. I have taken to the streets and jungles.

And in the course of these adventures, I have begun to see the multitudinal tiers of variable mental health system components-ethnic, sociocultural, religious, educational, psychological, and political-that need to be taken into consideration in the care of the mentally ill in the community. This book may not have clearly spelled out the inner workings of each variant, but we are being confronted by them every day. I strongly urge, therefore, that mental health researchers conduct more studies in these areas in the very near future.

In closing my book, I hope that if you've taken only one message with you that I tried to convey, no matter how implicitly, it is this: There is still hope for people in every ethnic group to come to live together with a child's innocence and a sage's heart.

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